DOI: https://doi.org/10.14710/jekk.v11i3.32399

Exposure to Urban Ambient Air Pollution and Adverse Pregnancy Outcome Risks: A Systematic Review

*Siti Mardhatillah Musa  -  Universitas Muhammadiyah Jakarta dan Universitas Muhammadiyah Tangerang, Indonesia
Muhammad Fachri  -  Universitas Muhammadiyah Jakarta, Indonesia
Nurmalia Lusida  -  Universitas Muhammadiyah Jakarta, Indonesia
Ika Oktaviani  -  Universitas Muhammadiyah Tangerang, Indonesia
Received: 25 May 2026; Revised: 2 Aug 2026; Accepted: 7 Aug 2026; Published: 12 Aug 2026.

Citation Format:
Abstract

Background: Urban ambient air pollution is an important environmental exposure during pregnancy because it can trigger inflammation, oxidative stress, endothelial dysfunction, placental impairment, and altered fetal development. Evidence remains heterogeneous because pollutant types, exposure windows, and pregnancy outcomes differ across studies.

Methods: This systematic review followed PRISMA 2020 principles and used a PECO framework. Searches were conducted in Scopus and ScienceDirect on April 23, 2026 and updated on May 06, 2026. From 3,547 identified records, 45 full-text articles were assessed and 20 articles were included in narrative synthesis. Evidence quality was appraised qualitatively using observational-study appraisal principles and JBI guidance.

Result: Key findings point to four important patterns. First, PM2.5, PM10, NO2, O3, SO2, black carbon, wildfire smoke, extreme heat, and heavy metals are most commonly associated with adverse externalities. Second, the preconception period, the first trimester, and the beginning of the second trimester are often sensitive exposure windows. Third, the strongest evidence appeared in gestational diabetes mellitus, gestational hypertension disorder, preeclampsia, fetal growth disorders, low birth weight, premature birth, autism spectrum disorder, epilepsy, as well as inflammatory biomarkers and oxidative stress. Fourth, the multipollutant approach is more appropriate because pregnant women are generally exposed to a mixture of pollutants, not just one pollutant.

Conclusion: Urban ambient air pollution should be considered an important environmental determinant of maternal and child health. Prevention requires antenatal education, individual exposure reduction, and urban emission-control policies.

Fulltext Email colleagues
Keywords: Ambient Air Pollution; Pregnancy; Adverse Pregnancy Outcomes; PM2.5.

Article Metrics:

Article Info
Section: Articles
Language : EN
  1. Gogna P, Borghese MM, Villeneuve PJ, Kumarathasan P, Johnson M, Shutt RH, et al. A cohort study of the multipollutant effects of PM2.5, NO2, and O3 on C-reactive protein levels during pregnancy. Environmental Epidemiology. 2024; 8:e308. https://doi.org/10.1097/EE9.0000000000000308
  2. Khalili R, Liu Y, Xu Y, O'Sharkey K, Pavlovic N, McClure C, et al. Adverse birth outcomes associated with heat stress and wildfire smoke exposure during preconception and pregnancy. Environmental Science & Technology. 2025;59:12458-12471. https://doi.org/10.1021/acs.est.4c10194
  3. Dai M, Liu J, Hu M, Zhang F, Wang Y, Dai F, et al. Air pollution exposure and gestational diabetes mellitus risk: a retrospective case-control study with multi-pollutant analysis in Wuhan, Hubei Province. Toxic. 2025;13:14. https://doi.org/10.3390/toxics13020141
  4. Meng Q, Liu J, Shen J, Del Rosario I, Janzen C, Devaskar SU, et al. Ambient exposure to fine particulate matter with oxidative potential affects oxidative stress biomarkers in pregnancy. American Journal of Epidemiology. 2025; 194(1):27-34. https://doi.org/10.1093/aje/kwae152
  5. Pedersen M, Nobile F, Stayner LT, de Hoogh K, Brandt J, Stafoggia M. Ambient air pollution and hypertensive disorders of pregnancy in Rome. Environmental Research. 2024;251:118630. https://doi.org/10.1016/j.envres.2024.118630
  6. Murphy MSQ, Abdulaziz KE, Lavigne E, Erwin E, Guo Y, Dingwall-Harvey ALJ, et al. Association between prenatal air pollutant exposure and autism spectrum disorders in young children: a matched case-control study in Canada. Environmental Research. 2024;261:119706. https://doi.org/10.1016/j.envres.2024.119706
  7. Sun Q, Chen Y, Ye F, Liu J, Liu D, Ao B, et al. Association of hypothyroidism during pregnancy with preconception and early pregnancy exposure to ambient particulate matter. Environmental Science and Pollution Research. 2023;30:88084-88094. https://doi.org/10.1007/s11356-023-28683-7
  8. Yan M, Liu N, Fan Y, Ma L, Guan T. Associations of pregnancy complications with ambient air pollution in China. Ecotoxicology and Environmental Safety. 2022;241:113727. https://doi.org/10.1016/j.ecoenv.2022.113727
  9. Miron-Celis M, Talarico R, Villeneuve PJ, Crighton E, Stieb DM, Stanescu C, et al. Critical windows of exposure to air pollution and gestational diabetes: assessing effect modification by maternal pre-existing conditions and environmental factors. Environmental Health. 2023;22:26. https://doi.org/10.1186/s12940-023-00974-z
  10. Abarca-Castro EA, Reyes-Lagos JJ, Guzman Ramos K, Montiel-Castro AJ, Arano-Varela H, Mayer-Villa PA, et al. Fetal development and the air pollution exposome: an integrative perspective of health pathways. Frontiers in Cellular Neuroscience. 2025;19:1688437. https://doi.org/10.3389/fncel.2025.1688437
  11. Bongaerts E, Lecante LL, Bove H, Roeffaers MBJ, Ameloot M, Fowler PA, Nawrot TS. Maternal exposure to ambient black carbon particles and their presence in maternal and fetal circulation and organs: an analysis of two independent population-based observational studies. The Lancet Planetary Health. 2022; 6(10):e804-e811. https://doi.org/10.1016/S2542-5196(22)00200-5
  12. Fussell JC, Jauniaux E, Smith RB, Burton GJ. Ambient air pollution and adverse birth outcomes: a review of underlying mechanisms. BJOG. 2023. https://doi.org/10.1111/1471-0528.17727
  13. Li M, Fan Q, Sun Y, Benmarhnia T, Chen JC, Jiao A, et al. Plant species richness, green spaces, and preterm birth risk in urban areas. Environment International. 2025;202:109644. https://doi.org/10.1016/j.envint.2025.109644
  14. Hodgson JR, Bartington S, Shi Z, Bloss WJ. Impact of air quality policy scenarios on pollution inequalities in a UK metropolitan area. Frontiers in Public Health. 2025;13:1690825. https://doi.org/10.3389/fpubh.2025.1690825
  15. Mazumder H, Rimu FH, Shimul MMH, Das J, Gain EP, Liaw W, Hossain MM. Maternal health outcomes associated with ambient air pollution: an umbrella review of systematic reviews and meta-analyses. Science of The Total Environment. 2024;169792. https://doi.org/10.1016/j.scitotenv.2023.169792
  16. Bekkar B, Pacheco S, Basu R, DeNicola N. Association of air pollution and heat exposure with preterm birth, low birth weight, and stillbirth in the US: a systematic review. JAMA Network Open. 2020; 3:e208243. https://doi.org/10.1001/jamanetworkopen.2020.8243
  17. Decrue F, Miller MR, Newby DE, Reynolds RM. Ambient air pollution and maternal cardiovascular health in pregnancy. Heart. 2023. https://doi.org/10.1136/heartjnl-2022-322259
  18. Yount C, Scheible K, Thurston SW, Qiu X, Ge Y, Hopke PK, et al. Short term air pollution exposure during pregnancy and associations with maternal immune markers. Environmental Research. 2024;119639. https://doi.org/10.1016/j.envres.2024.119639
  19. Eberle C, Stichling S. Environmental health influences in pregnancy and risk of gestational diabetes mellitus: a systematic review. BMC Public Health. 2022;22:1572. https://doi.org/10.1186/s12889-022-13965-5
  20. Basilio E, Zlatnik MG. Extreme weather-Wildfires & pregnancy. Seminars in Perinatology. 2023;47:151839. https://doi.org/10.1016/j.semperi.2023.151839
  21. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. https://doi.org/10.1136/bmj.n71
  22. Munn Z, Aromataris E, Tufanaru C, Stern C, Porritt K, Farrow J, et al. The development of software to support multiple systematic review types: the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information. Int J Evid Based Healthc. 2019; 17(1):36-43. https://doi.org/10.1097/XEB.0000000000000152
  23. Hu Y, Chavez T, Eckel SP, Yang T, Chen X, Vigil M, et al. Joint effects of traffic-related air pollution and hypertensive disorders of pregnancy on maternal postpartum depressive and anxiety symptoms. Journal of Exposure Science & Environmental Epidemiology. 2025;35:278-287. https://doi.org/10.1038/s41370-024-00692-9
  24. Yu X, Rahman MM, Carter SA, Lin JC, Zhuang Z, Chow T, et al. Prenatal air pollution, maternal immune activation, and autism spectrum disorder. Environment International. 2023;179:108148. https://doi.org/10.1016/j.envint.2023.108148
  25. Cotter DL, Morrel J, Sukumaran K, Cardenas-Iniguez C, Schwartz J, Herting MM. Prenatal and childhood air pollution exposure, cellular immune biomarkers, and brain connectivity in early adolescents. Brain, Behavior, & Immunity - Health. 2024;38:100799. https://doi.org/10.1016/j.bbih.2024.100799
  26. Zhang Y, Liu J, Hu M, Chai D, Zhang F, Yin T, et al. The relationship between air pollution and the occurrence of hypertensive disorders of pregnancy: evidence from a study in Wuhan, China. Ecotoxicology and Environmental Safety. 2024;284:116933. https://doi.org/10.1016/j.ecoenv.2024.116933
  27. Lee KS, Min WK, Choi YJ, Jin S, Park KH, Kim S. The effect of maternal exposure to air pollutants and heavy metals during pregnancy on the risk of neurological disorders using the National Health Insurance Claims Data of South Korea. Medicine. 2023;59:951. https://doi.org/10.3390/medicina59050951
  28. Trushna T, Yadav V, Mandal UK, Diwan V, Tiwari RR, Ahirwar R, et al. A protocol for estimating health burden posed by early life exposure to ambient fine particulate matter and its heavy metal composition: a mother-child birth cohort from Central India. Frontiers in Public Health. 2025;13:1485417. https://doi.org/10.3389/fpubh.2025.1485417
  29. Zhang H, Wang Q, He S, Wu K, Ren M, Dong H, et al. Ambient air pollution and gestational diabetes mellitus: a review of evidence from biological mechanisms to population epidemiology. Science of the Total Environment. 2020;719:137349. https://doi.org/10.1016/j.scitotenv.2020.137349
  30. Gao S, Zhang H, Kang X, Cui XP. Prenatal PM2.5 exposure and hypertensive disorders of pregnancy: a systematic review and meta-analysis. Frontiers in Public Health. 2025;13:1650913. https://doi.org/10.3389/fpubh.2025.1650913
  31. Varshavsky J, Smith A, Wang A, Hom E, Izano M, Huang H, et al. Heightened susceptibility: a review of how pregnancy and chemical exposures influence maternal health. Reproductive Toxicology. 2020;92:14-56. https://doi.org/10.1016/j.reprotox.2019.12.004
  32. Parasin N, Amnuaylojaroen T, Saokaew S. Prenatal PM2.5 exposure and its association with low birth weight: a systematic review and meta-analysis. Toxic. 2024;12:446. https://doi.org/10.3390/toxics12070446
  33. Desye B, Berihun G, Geto AK, Berhanu L, Daba C. Exposure to ambient air pollution and its association with adverse birth outcomes: a systematic review and meta-analysis of epidemiological studies. Frontiers in Public Health. 2024;12:1488028. https://doi.org/10.3389/fpubh.2024.1488028
  34. Aguilera J, Konvinse K, Lee A, Maecker H, Prunicki M, Mahalingaiah S, et al. Air pollution and pregnancy. Seminars in Perinatology. 2023;47:151838. https://doi.org/10.1016/j.semperi.2023.151838
  35. Zhao Y, Qu Y, Huang X, Wu F, Sun S, Qin R, et al. Ambient ozone exposure and pregnancy complications and adverse birth outcomes: a systematic review and meta-analysis. Environmental Research. 2025;120996. https://doi.org/10.1016/j.envres.2025.120996
  36. Heft-Neal S, Driscoll A, Yang W, Shaw G, Burke M. Associations between wildfire smoke exposure during pregnancy and risk of preterm birth in California. Environmental Research. 2022;203:111872. https://doi.org/10.1016/j.envres.2021.111872
  37. Requia WJ, Papatheodorou S, Koutrakis P, Mukherjee R, Roig HL. Increased preterm birth following maternal wildfire smoke exposure in Brazil. International Journal of Hygiene and Environmental Health. 2022;240:113901. https://doi.org/10.1016/j.ijheh.2021.113901
  38. Yuan L, Zhang Y, Wang W, Chen R, Liu Y, Liu C, et al. Critical windows for maternal fine particulate matter exposure and adverse birth outcomes: the Shanghai birth cohort study. Chemosphere. 2020;240:124904. https://doi.org/10.1016/j.chemosphere.2019.124904
  39. Haikerwal A, Doyle LW, Wark JD, Irving L, Cheong JLY. Wildfire smoke exposure and respiratory health outcomes in young adults born extremely preterm or extremely low birthweight. Environmental Research. 2021;197:111159. https://doi.org/10.1016/j.envres.2021.111159
  40. Kim JH, Choi YY, Yoo SI, Kang DR. Association between ambient air pollution and high-risk pregnancy: a 2015-2018 national population-based cohort study in Korea. Environmental Research. 2021;197:110965. https://doi.org/10.1016/j.envres.2021.110965
  41. Yang BY, Qu Y, Guo Y, Markevych I, Heinrich J, Bloom MS, et al. Maternal exposure to ambient air pollution and congenital heart defects in China. Environment International. 2021;153:106548. https://doi.org/10.1016/j.envint.2021.106548
  42. Chen YT, Liu CL, Chen CJ, Chen MH, Chen CY, Tsao PN, et al. Association between short-term exposure to air pollution and sudden infant death syndrome. Chemosphere. 2021;271:129515. https://doi.org/10.1016/j.chemosphere.2020.129515
  43. Li J, Guan T, Guo Q, Geng G, Wang H, Guo F, et al. Exposure to landscape fire smoke reduced birthweight in low- and middle-income countries: findings from a siblings-matched case-control study. eLife. 2021; 10:e69298. https://doi.org/10.7554/eLife.69298

Last update:

No citation recorded.

Last update:

No citation recorded.